Oncology Payment Models Fall Short of Desired Goals

Allison Inserro
Published: Wednesday, Feb 05, 2020
Stephen M. Schleicher, MD, MBA, a cochair of the meeting, an oncologist at Tennessee Oncology, and chair of the Quality and Value Committee of OneOncology

Stephen M. Schleicher, MD, MBA

There is a year and a half remaining in the life of the Oncology Care Model (OCM), and although the Centers for Medicare & Medicaid Services (CMS) has leapt forward with a vision for the next-generation model of care Oncology Care First (OCF), many stakeholders feel that the OCM is more than enough to think about right now.

 

Table 1. Key Differences Between the OCM and the Proposed OCF (Click to Enlarge)

Oncologists and others who crowded into a Nashville, Tennessee, ballroom for an Institute for Value-Based Medicine® forum, an initiative of The American Journal of Managed Care®, recently shared their thoughts, successes, and frustrations regarding the OCM.

Oncologists, through their experience with the OCM so far, do have a valuable body of knowledge that can inform decisions about patient care, said Stephen M. Schleicher, MD, MBA, a cochair of the meeting, an oncologist at Tennessee Oncology, and chair of the Quality and Value Committee of OneOncology, a network of community oncology practices. This knowledge needs to be enriched with further observation, and it also needs to be conveyed to those who have authoritative roles in patient care management, such as payers, he said.

“I think we’re ahead of the game on this,” Schleicher said. In his view, the oncology community should do the following 3 things:
  • Understand the oncology models in depth because valuebased care (VBC) is here to stay.
  • Educate payers on how to improve their policies to ensure that cost control does not come at patients’ expense.
  • Optimize care coordination to prevent avoidable emergency department (ED) visits and hospitalizations, facilitate end-of-life care planning, and avoid unnecessary tests and pharmaceutical use.
Oncologists should think carefully about the need for medical tests and drugs before ordering them, he said. In this way, they can remain faithful to the tenets of VBC. “Think before that PET [positron emission tomography] scan, think before prescribing that expensive drug. Do we have a biosimilar instead?” he said.

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